Imagine if Republicans actually cared about health care

In a functional democracy, Democrats and Republicans would work together to iron out the kinks and create a better health care system for America. We don’t have a fully functional democracy, but there’s a good chance the Affordable Care Act will make health care in America better and fairer anyway.

“We’re not in Kansas anymore,” said the smirking congressman from Texas, pleased with his own witlessness.

Rep. Joe Barton, a Republican, was addressing Kathleen Sebelius, a former governor of Kansas, now secretary of health and human services, who is in the hot seat over the bug-ridden website her department introduced to enroll Americans in insurance plans under the Affordable Care Act.

I live in Missouri, but know Kansas — it’s where my mother’s people are from — and I live close enough to spit on it, not that I would. I know more than a little about Sebelius, and she’s far more knowledgeable about health care than just about any combination of her GOP interrogators. As Kansas insurance commissioner, she was a strong defender of the rights of the insured and did not shrink from strong action on their behalf.

The putdowns Sebelius endured during her testimony before the House Energy and Commerce Committee were entirely predictable. The same yahoos in Congress who were content to force the United States into default unless Obamacare was repealed have pivoted to outrage that the Obama administration has failed to deliver Obamacare seamlessly to the American people.

But let’s consider the merits of the controversy. Like most Americans, I’d like to know why Healthcare.gov was botched. I’d like to know how it can be fixed, and when. I’d like to know if its problems are endemic to large government software projects and, if so, what our government can do to prevent things like this from happening in the future. I’d even like to know if any of the fault lies with incompetence on Sebelius’ part.

Fair-minded people of good will have reason to be disgusted with how Obamacare was unveiled. But the website and its problems don’t shed any discredit on the law’s objectives or the means to achieve them. We know that many major government programs, including Medicare, had rocky starts on the administrative front.

Nonetheless, another argument has emerged that does call into question the ACA’s objectives, and the promise the president made to those who feared losing their current insurance plan once the law went into effect. That promise appears to have been broken, as various commentators have brought forth examples of insurance companies notifying customers that their policies are being cancelled in compliance with the law.

It is misleading to imply, however, that people are having fantastic health care plans yanked away. Because of Obamacare, they are being offered new plans that increase their coverage; for the first time, they cannot be denied for pre-existing conditions, their emergency room visits and mental health treatment will be covered, along with prescription drugs and preventative care, to list a few of the upgrades.

The people affected are the 5 percent of Americans who buy insurance as individuals and families. Many of those plans were bare bones in coverage and do not meet the higher standards called for by the ACA. So companies are ending them, offering new options through the exchanges, with tax subsidies to offset the higher costs for some of these customers.

One troubling aspect of the way the Obama administration talked up the ACA was the emphasis on what might be called the consumer experience. Hey, log on to Healthcare.gov and shop for insurance just as you’d buy toothpaste or a book at Amazon.com!

Thing is, the last time I placed an order, Amazon.com didn’t funnel my request through at least nine federal agencies, as the Affordable Care Act website must traverse. Amazon doesn’t need to check with the Social Security Administration for my identity, they don’t care if the Department of Homeland Security knows that I am a U.S. citizen or if I’m getting any benefits that the IRS can verify as it checks my income.

The kludginess of Obamacare is a feature, not a bug. Want simple? Let’s universalize Medicare, or enact some other national health scheme. But, no, we’re not going there.

The point of Obamacare is to insure the uninsured, which is the right thing to do, and to protect those not in perfect health from pre-existing condition exclusions and other anti-consumer features of health insurance as it was. The hope is that this will save money, both in the aggregate and for individuals who must buy their own insurance on the open market. And it’s looking like it will, for most people, but the truth is that we won’t know until we’re further down the road.

In a functional democracy, Democrats and Republicans would work together to iron out the kinks and create a better health care system for America. We don’t have a fully functional democracy, but there’s a good chance the ACA will make health care in America better and fairer anyway.